Kawano Takahisa, Nishiyama Kei, Hayashi Hiroyuki
Department of Emergency Medicine, University of Fukui Hospital, Fukui, Japan.
Department of Primary Care and Emergency Medicine, Kyoto University Graduate School of Medicine, Kyoto city, Japan.
PLoS One. 2014 Oct 13;9(10):e108447. doi: 10.1371/journal.pone.0108447. eCollection 2014.
We compared the effects of execution of diagnostic tests in the emergency department (ED) and other common factors on the length of ED stay to identify those with the greatest impacts on ED crowding.
Between February 2010 and January 2012, we conducted a cross-sectional, single-center study in the ED of a large, urban, teaching hospital in Japan. Patients who visited the ED during the study period were enrolled. We excluded (1) patients scheduled for admission or pharmaceutical prescription, and (2) neonates requiring intensive care transferred from other hospitals. Multivariate linear regression was performed on log-transformed length of ED stay in admitted and discharged patients to compare influence of diagnostic tests and other common predictors. To quantify the range of change in length of ED stay given a unit change of the predictor, a generalized linear model was used for each group.
During the study period, 55,285 patients were enrolled. In discharged patients, laboratory blood tests had the highest standardized β coefficient (0.44) among common predictors, and increased length of ED stay by 72.5 minutes (95% CI, 72.8-76.1 minutes). In admitted patients, computed tomography (CT) had the highest standardized β coefficient (0.17), and increased length of ED stay by 32.7 minutes (95% CI, 40.0-49.9 minutes). Although other common input and output factors were significant contributors, they had smaller standardized β coefficients in both groups.
Execution of laboratory blood tests and CT had a stronger influence on length of ED stay than other common input and output factors.
我们比较了在急诊科执行诊断检查的效果以及其他常见因素对急诊科留观时间的影响，以确定那些对急诊科拥挤影响最大的因素。
在2010年2月至2012年1月期间，我们在日本一家大型城市教学医院的急诊科进行了一项横断面单中心研究。纳入了研究期间到急诊科就诊的患者。我们排除了（1）计划入院或接受药物处方的患者，以及（2）从其他医院转来需要重症监护的新生儿。对入院和出院患者的急诊科留观时间进行对数转换后进行多变量线性回归，以比较诊断检查和其他常见预测因素的影响。为了量化预测因素单位变化时急诊科留观时间的变化范围，对每组使用广义线性模型。
在研究期间，共纳入55285例患者。在出院患者中，实验室血液检查在常见预测因素中标准化β系数最高（0.44），使急诊科留观时间延长72.5分钟（95%CI，72.8 - 76.1分钟）。在入院患者中，计算机断层扫描（CT）标准化β系数最高（0.17），使急诊科留观时间延长32.7分钟（95%CI，40.0 - 49.9分钟）。虽然其他常见的输入和输出因素也是重要因素，但在两组中它们的标准化β系数较小。
实验室血液检查和CT的执行对急诊科留观时间的影响比其他常见的输入和输出因素更强。
